Revival of Cutaneous Leishmaniasis in Southern Districts of KP Pakistan

Abstract

A neglected tropical disease “Leishmaniasis” is still a threat to people residing in the southern districts of KP. The protozoan parasite of the genus Leishmania is the causative agent which is transmitted by female sand fly. Sand flies become infected by sucking blood from an infected animal or person. People might not realize that sand flies are present because of smaller size, noiseless and painless bite. Sand flies usually are most active in twilight, evening, and night-time hours (from dusk to dawn). 

There are three main forms of Leishmaniasis; cutaneous Leishmaniasis, visceral Leishmaniasis and mucosal Leishmaniasis. Of these, cutaneous Leishmaniasis is the most common form. It affects the skin and mucous membranes. Clinical manifestations range from skin sores to systemic multiorgan disease. Cutaneous symptoms may appear a few weeks after being bitten by an infected sand fly. However, sometimes symptoms won't appear for months or years. The sores can change in size and appearance over time. The sores may start out as papules (bumps) or nodules (lumps) and may end up as ulcers (like a volcano, with a raised edge and central crater); skin ulcers might be covered by scab or crust.  Tissue specimens [skin sores] can be examined for the parasite under a microscope, in special cultures, and by molecular tests.

The lack of information and facilities about the disease [diagnosis/treatment] lead to the spread of infection at an alarming rate in this region. Huge migration of people from boarder areas between Pakistan and Afghanistan due to terrorism and economic conditions contributed a lot to the spread of infection. According to recent reports, the prevalence of the disease is much higher in these areas compared to it prevalence in district Peshawar. This high prevalence is attributed to the close relationship of peoples with animals, frequent utilization of animal dungs and contaminated woods as a fuel and no use of disinfectants. The lack of a commercially available vaccines, the lack of access to therapy and limited local resources are among the main contributing factors for the spread of infection.

Public health activities including knowledge of infection and methods of control [limiting close contact with animals, wearing of full sleeves shirt & use of bed nets] can play a substantial role in controlling the spread of the disease. In general, prevention and control measures must be tailored to the local setting. Control measures against sand fly vectors or animal reservoir hosts might be an effective tool.